BIA-ALCL January 2018 Breast Implant Associated Lymphoma Update

Posted January 13, 2018 in Home, Patient Safety

Through the years, I have posted several updates on the rare, but very treatable, Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) on the San Francisco Plastic Surgery Blog. As of January 4, 2018, a pivotal new study was released in JAMA Oncology.

An advanced case of BIA-ALCL. Arrows on this MRI point to white patches of increased fluid around the tumor cells.

An advanced case of BIA-ALCL. Arrows on this MRI point to white patches of increased fluid around the tumor cells.

What Is The Risk of BIA-ALCL in Women With Breast Implants?

The article, available on-line, is titled, “Breast Implants and the Risk of Anaplastic Large-Cell Lymphoma in the Breast.” The key question which the authors tried to answer is, “What are the relative and absolute risks of breast anaplastic large-cell lymphoma (ALCL) in women with breast implants?”

To properly frame the answer obtained, it is important to note that BIA-ALCL is not breast cancer. However, the relative risk of BIA-ALCL compared to the risk of breast cancer is often used to give proper reference to how rare BIA-ALCL is.

What Was Found – The Absolute Numbers

The study utilized the Netherlands’ Nationwide Network and Registry of Histo- and Cytopathology (PALGA). Over the 27 years, the study identified 32 patients with primary breast ALCL with a breast implants. Overall, 782 female patients were diagnosed with a non-Hodgkin lymphoma (NHL) of the breast in the Netherlands during 1990 to 2016. 43 primary breast-ALCL cases were confirmed. The median age of the 43 patients with breast-ALCL was 59 years. 32 of these patients had ipsilateral (same sided) breast implants, compared with 1 among 146 women with other primary breast lymphomas (OR, 421.8; 95% CI, 52.6-3385.2).

Other Associations With BIA-ALCL

BIA-ALCL seems to form on the surface of textured breast implants. The cells can also be found in the fluid  that accumulates around the breast implant. The bacteria that form a biofilm around the textured implants have been associated with this tumor.

BIA-ALCL seems to form on the surface of textured breast implants. The cells can also be found in the fluid that accumulates around the breast implant. The bacteria that form a biofilm around the textured implants have been associated with this tumor.

BIA-ALCL is associated with textured breast implants. Out of 109,448 breast implants sold in the Netherlands, 49,109 were textured (P < 0.01). This means of the breast implants sold in the Netherlands, and presumably used, 45% are textured. In this study, however, 23 of 28 patients diagnosis with BIA-ALCL had textured breast implants at the time of their diagnosis or 82%. So the actual number of BIA-ALCL cases associated with textured implants was almost twice what would be expected if BIA-ALCL occurred at the same rate in textured and smooth breast implants. Even more importantly, in this study, it was unknown if the patients with smooth implants had previously had textured breast implants, but more on that below.

Textured Breast Implants & BIA-ALCL

The Plastic Surgery Foundation has the most complete and largest database of BIA-ALCL cases. As of December 1, 2017, of the 183 unique reported cases in the PROFILE database, every patient has had a textured breast implant prior to their diagnosis. Even women who had smooth breast implants at the time of their BIA-ALCL diagnosis, had previously had either a textured breast implant or a textured tissue expander prior to receiving their smooth breast implants.

Comparisons With Breast Cancer

If you live to 80 years of age, your risk of developing breast cancer is 1:8. If you have breast implants, your risk of developing BIA-ALCL ranges from 1:1000 to 1:30,000 for women with textured breast implants, depending on which epidemiological study you read. In 2018, about 40,920 women in the U.S. are expected to die from breast cancer. World wide there have been 17 deaths from BIA-ALCL over the 56 years that breast implants have been available. Like breast cancer, early diagnosis is the key to a cure. Unlike breast cancer, BIA-ALCL is very treatable.

The Signs of BIA-ALCL

Current treatment of BIA-ALCL is usually curative, but depends on early diagnosis and appropriate treatment.

Current treatment of BIA-ALCL is usually curative, but depends on early diagnosis and appropriate treatment.

Although it is unlikely that a woman with breast implants will ever have to deal with BIA-ALCL, it is important to know the symptoms and seek care if they develop. When BIA-ALCL is confined to the capsule, removing the breast implants and capsules has been curative for every patient to date. The majority of early stage patients require no additional treatment. Chemotherapy is required for unresectable disease to metastasis.

Delaying or declining treatment is not advisable. Analysis of the known deaths from BIA-ALCL revealed that patients either received radiation (x-ray therapy) or chemotherapy alone, died of the treatment itself, had incomplete surgical resection or had distant metastasis. All cases of BIA-ALCL should be reported to the PROFILE registry.

BIA-ALCL usually presents as unilateral (one-sided) swelling of the breasts, an average of 8-9 years after the insertion of textured breast implants (range 2-28 years reported). This can occur even if the breast implants have been replaced with smooth breast implants. Fluid around a textured breast implant is not usually due to BIA-ALCL, but it can be sent for analysis when the conditions are suspicious. BIA-ALCL can also present as a lump in the breast or in the armpit like breast cancer does.

Risk Factors

The FDA does not recommend any additional screening or treatment for BIA-ALCL. BIA-ALCL is extremely rare, and it is impossible to predict who will develop it, but there are 4 identified risk factors: TIMD

  1. T – Textured Breast Implants – There have been no reported smooth-walled device cases at this time.
  2. I – Inflammation – Chronic inflammation has been implicated. Certain bacteria in the biofilm that forms around breast implants have been associated with an increased risk of BIA-ALCL.
  3. M – Mutations – There may be a link with genetic mutations in JAK1 and STAT3. Further research is necessary.
  4. D – Duration of Augmentation – Presentation is usually 8-9 years after textured breast implant insertion.

What To Do If You Suspect You Have BIA-ALCL

Get checked out. See your primary medical doctor or your plastic surgeon. Get an updated medical history and physical examination. If enough fluid is present around the breast implant, a sample can be sent for analysis. 2-3 tablespoons are required for cytology and CD30 immunohistochemisty to rule out BIA-ALCL. Mammograms are not useful. PET/CT scans are used for staging.

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Breast Implant Revision SF Bay Area

Posted September 25, 2017 in Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Revision Surgery, Home, Videos

Breast Augmentation with Breast Implants remains the most popular cosmetic plastic surgery. Three to four-hundred-thousand women have Breast Augmentation each year in the US alone. It is the safest and most effective means of enlarging the breasts available, but even FDA approved devices, like Breast Implants, need touch-ups from time-to-time.

Do I Need Breast Implant Revision Surgery?

The following Breast Implant Revision Surgery Video originally aired on the San Francisco Bay Area‘s news Station, KRON 4. It reviews Breast Augmentation Revision Options and describes some of the most common breast augmentation revisions. Multiple before and after pictures are included as examples.

Breast Augmentation Revision Surgery Video

Breast Implant Deflation

The introductory photo for the video above shows deflation of this patient’s left breast implant. For Saline Breast Implants, loss of the breast implant’s shell integrity results in complete deflation and loss of breast augmentation. Replacement of a deflated breast implant can be done with minimal downtime. It is also a good time to consider if your breast implants are the right size, profile or style (saline vs silicone), as there is no better time to replace both implants. In situations like the above, it is extremely helpful if you know what type and size of breast implants you have.

Breast Implant Revision – Bigger

The most common reason for Breast Augmentation Revisions is to go bigger. This is especially common after pregnancy with preexisting breast implants as shown above.

The most common reason for Breast Augmentation Revisions is to go bigger. This is especially common after pregnancy with preexisting breast implants as shown above.

The above Breast Implant Revision Before and After Pictures show two common reasons for revision. The first, and the most common, is to go larger. The second, and often seen after pregnancy with preexisting breast implants, is to correct breast tissue sagging off the breast implants.

This patient has already had a Breast Augmentation Mastopexy, also known as a breast lift, using breast implants for additional volume. The larger the preexisting breast tissue volume, the more likely the breast is to sag. This is true with or without breast implants. She desired larger breasts and a perkier appearance. A larger Breast Implant provides both additional volume and support for her breasts.

Breast Implant Revision – Smaller

The above Breast Augmentation Revision pictures demonstrate the correction of bottoming out.

The above Breast Augmentation Revision pictures demonstrate the correction of bottoming out.

Sometimes, the breast implants are too large to be supported. The before picture, in the above Breast Augmentation Revision Before and After Pictures, demonstrates what happens when breast implants are too large, even with a breast lift. Over time, the Breast Implants have over-stretched the skin of the lower breast and moved down the chest. The previous breast lift (mastopexy) scar is red and irritated, and the nipple is riding high. This patient presented with a desire for correction of the shape of her breasts, and also wanted to be smaller.

The after photo shows the results after the mastopexy was revised and the breast implants were replaced with smaller, lower profile, Breast Implants. The mastopexy scar looks less irritated. The distance between the nipples and the bottom of the breast is reduced to normal. The new breast implants are smaller, but maintain the width of the breast to preserve cleavage.

Breast Implant Revision Surgery Consultations

With the popularity of Breast Implants it is not surprising that Breast Augmentation Revision Surgery has become its own specialty. If you have breast implants which are:

  • too small
  • too large
  • too high
  • too low
  • too close together
  • too far apart
  • too hard
  • deflated or leaking
  • not supporting your breast tissue

then give my San Francisco Bay Area Plastic Surgery Clinic a call at (925) 943-6353. With 20 years of experience, I will give you up-to-date options that are personalized to your unique situation. Previous operative reports and your before and after pictures help, so bring them with you, too.

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New Body Beautiful From Head to Tummy

Posted September 09, 2017 in Breast Augmentation, Breast Implant Revision Surgery, Breast Reduction, Breast Reduction (Men), Capsular Contracture, Ear Shaping (Otoplasty), Home, Tummy Tuck (Abdominoplasty)

Dr. Mele discusses Cosmetic Plastic Surgery on Body Beautiful - September 12, 2017, at Noon.

Dr. Mele discusses Cosmetic Plastic Surgery on Body Beautiful – September 12, 2017, at Noon.

Hey San Francisco Bay Area. Body Beautiful will be broadcast this Tuesday, September 12, at noon. You may not have noticed, but KRON 4 was acquired by Nexstar. The good news is that they have decided to continue Body Beautiful, so I’ve got new Plastic Surgery News to share with you.

Body Beautiful on KRON 4

KRON 4's Body Beautiful with Vicki Liviakis and yours truly on the San Francisco Bay Area's News Station.

KRON 4’s Body Beautiful with Vicki Liviakis and yours truly on the San Francisco Bay Area’s News Station.

I have been doing Body Beautiful live for the last 10 years. The original show was with host Vicki Liviakis, and we would take viewer calls live, on the air. It certainly added excitement. Since we were on the air live, even the “unusual” questions had to be answered.

The latest version of Body Beautiful with host Janelle Marie.

The latest version of Body Beautiful with host Janelle Marie.

Now Janelle Marie is the host, but the format remains the same. This week’s show was taped last week. Maybe KRON’s new management was a little nervous about an amateur, me, on the air live. But don’t worry, you can still submit questions for the show via email or the contact form here in the margin.

This Week’s Body Beautiful Discussion

This week’s show is dedicated to four Cosmetic Plastic Surgery Procedures:

The links above will take to more detailed information about these procedures.

Body Beautiful Airs Tuesday At Noon

Body Beautiful will be broadcast this Tuesday, September 12, at noon. Be sure to tune in or set your DVR. I you miss it, don’t worry. I will be posting the segments from the show here, and the San Francisco Plastic Surgery Blog and on my YouTube channel.

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Breast Implant Warranties – SF Bay Area

Posted July 30, 2017 in Breast Augmentation, Breast Implant Revision Surgery, Home

If you have Breast Implants, here's some peace of mind to help you chill this summer.

If you have Breast Implants, here’s some peace of mind to help you chill this summer.

Did you know your Breast Implants come with a manufacturer’s warranty? It’s true. All FDA approved Breast Implants in the US come with a Breast Implant Warranty automatically. The details of coverage have changed throughout the years, but here are the latest details for the summer of 2017.

The Big Three Breast Implant Manufacturers

In the US, there are currently three FDA approved Breast Implant manufacturers:

  • Natrelle® (Allergan)
  • Mentor (Johnson & Johnson)
  • Sientra

Below are the latest details. These have been fairly consistent over the last two decades; however, contact your breast implant’s manufacturer directly for the latest information.

Allergan Natrelle® ConfidencePlus® Warranty

Natrelle breast implants are manufactured by Allergen.

Natrelle breast implants are manufactured by Allergan.

The following applies to Breast Augmentation using Natrelle® breast implants performed on or after November 1, 2014.

Enrollment:

  • For Natrelle® Silicone Gel Breast Implants:
    • Automatic and Free
  • For Natrelle® Saline Breast Implants:
    • Standard Warranty: Automatic and Free
    • ConfidencePlus® Premier: Enroll within 45 days and pay $200

Coverage:

  • Natrelle® Silicone Gel Breast Implant coverage:
    • Lifetime FREE breast implant replacement for rupture
    • 10-year FREE breast implant replacement for grade III or IV capsular contracture
    • 10-year up to $3500 surgery cost assistance for rupture
  • Natrelle® Saline Breast Implant coverage:
    • Standard Natrelle® Saline Breast Implant coverage:
      • Lifetime FREE breast implant replacement for rupture (deflation)
    • Premier Natrelle® Saline Breast Implant coverage:
      • Lifetime FREE breast implant replacement for rupture
      • 10-year up to $2400 surgery cost assistance for rupture

Mentor® MentorPromise Warranty

Mentor breast implants are manufactured by Johnson & Johnson.

Mentor breast implants are manufactured by Johnson & Johnson.

The following applies to Breast Augmentation using Mentor® breast implants performed on or after May 1, 2017.

Enrollment:

  • For Mentor® Silicone Gel Breast Implants:
    • Basic warranty: Automatic and Free
    • Enhanced warranty: Enroll within 45 days and pay $300
  • For Mentor ® Saline Breast Implants:
    • Basic Warranty: Automatic and Free
    • Enhanced warranty: Enroll within 45 days and pay $200

Coverage:

  • Mentor ® Silicone Gel Breast Implant coverage:
    • Basic Mentor® Silicone Gel Breast Implant coverage:
      • Lifetime FREE breast implant replacement for rupture
      • 10-year up to $3500 surgery cost assistance for rupture
    • Enhanced Mentor® Silicone Gel Breast Implant coverage:
      • Lifetime FREE breast implant replacement for rupture
      • 10-year up to $3500 surgery cost assistance for rupture, grade III or IV capsular contracture, double bubble or late seroma
  • Mentor ® Saline Breast Implant coverage:
    • Basic Mentor® Saline Breast Implant coverage:
      • Lifetime FREE breast implant replacement for rupture (deflation)
    • Enhanced Mentor® Saline Breast Implant coverage:
      • Lifetime FREE breast implant replacement for rupture
      • 10-year up to $2400 surgery cost assistance for rupture

Sientra® Warranty

Sientra manufactures only silicone breast implants for use in the US.

Sientra manufactures only silicone breast implants for use in the US.

Sientra® offers the following Breast Implant Warranty on all their breast implants.

Enrollment:

  • For Sientra ® Silicone Gel Breast Implants:
    • Sientra warranty: Automatic and Free

Coverage:

  • For Sientra ® Silicone Gel Breast Implants:
    • Lifetime FREE breast implant replacement for rupture
    • 10-year up to $3600 surgery cost assistance for rupture
    • 5-year FREE breast implant replacement for grade III or IV capsular contracture

Breast Implant Warranty Updates

Breast Implant Manufacturers are constantly updating their warranties. Be certain to check with your Board Certified Plastic Surgeon and your Breast Implant’s manufacturer for the latest details.

If you are considering Breast Augmentation or Breast Implant Revision Surgery, give my San Francisco Bay Area Plastic Surgery Clinic a call today at (925) 943-6353.

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San Francisco Breast 2.0 Enhancement (Augmentation, Lift and Reduction)

Posted July 09, 2017 in Areolar Reduction, Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Options, Breast Implant Revision Surgery, Breast Lift (Mastopexy), Breast Reduction, Breast Reduction (Men), Breast Reduction (Women), Capsular Contracture, Home, Inverted Nipples, Nipple Reduction, Tubular Breasts

New Breast Enhancement Content

SanFranciscoBreast.com has been completely updated. This update includes new content, and it is artfully illustrated with new breast enhancement videos and more before and after pictures. In addition, the fresh content is wrapped in a new skin, improving navigation for the small screen and the desktop alike.

New Breast Augmentation Information

The site includes new pages featuring the most requested Breast Enhancement Procedures. For example, the Breast Augmentation Information has been exploded into a dozen detailed pages including:

  • Breast Augmentation
  • Breast Implant Options
  • Breast Augmentation Incisions
  • Breast Implant Placement
  • Today’s Breast Implants
  • History of Breast Implants
  • Breast Implant Warranties
  • Breast Implant Care
  • Breast Augmentation Lift
  • Breast Augmentation Revision
  • An Expanded Breast Augmentation Photo Gallery
  • And Hours of Breast Augmentation Videos

Breast Implant Revision Surgery

The Breast Augmentation Revision Section includes pages devoted to specific problems like:

  • Capsular Contracture
  • Breast Implant Deflation
  • Breast Implant Infection
  • Breast Implant Malposition
  • Breast Implant Removal
  • Breast Implant Rippling
  • Breast Implant Scar Revision
  • Breast Implant Replacement
  • Breast Lifts (Mastopexy)

    The Breast Lift section includes details about five main options for Mastopexy. There are also pages dedicated to the combination of Breast Lift using Breast Implants and Areola Reduction.

    Breast Reduction for Women and Men

    Options for Breast Reduction for Women are also reviewed, as several techniques have evolved during the 20+ years I have been in practice. Breast Reduction for Men, also known as Gynecomastia Reduction, is covered with attention paid to the causes and the most current treatments available.

    Specialty Breast Procedures

    A section on the often overlooked details of Breast Enhancement is also included. San Francisco Breast’s Specialty Breast Pages include:

    • Inverted Nipple Correction
    • Areola Reduction
    • Nipple Reduction
    • Tubular Breasts
    • Poland Syndrome
    • Other Congenital Breast Abnormalities
    • Areola Reconstruction
    • Nipple Reconstruction

    A Plastic Surgery Web Site Dedicated to Breast Enhancement

    I have tried to create an all inclusive Breast Enhancement site designed to provide detailed information about the many Plastic Surgery options available for Breast Enhancement, whether that be Breast Enlargement, Breast Reduction or Breast Reshaping.

    While the San Francisco Breast web site in meant to provide information, it is just a starting point. The Internet cannot take the place of a thoughtful, in-person consultation with a qualified Board Certified Plastic Surgeon. If you would like to schedule a private, personalized consultation appointment call (925) 943-6353 today. My San Francisco Bay Area Plastic Surgery clinic specializes in helping you obtain the best possible results.

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Breasts, Belly and Bootie Lifts – SF Bay Area Plastic Surgery

Posted June 04, 2017 in Areolar Reduction, Brazilian Butt Lift, Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Revision Surgery, Breast Lift (Mastopexy), Breast Reduction, Breast Reduction (Women), Butt Lifts, Fat Grafting, Home, Inverted Nipples, Liposuction, Mini Tummy Tuck (Mini Abdominoplasty), Mommy Makeover, Post-Bariatric Surgery (After Weight Loss), Thigh Lifts (Thighplasty), Tummy Tuck (Abdominoplasty)

The Mommy Makeover is the most popular, and one of the most satisfying, combination cosmetic plastic surgery procedures. With the ability to reshape the breast and flatten the belly, the Mommy Makeover is the procedure of choice to rejuvenate the female form after pregnancy or weight loss.

The Mommy Makeover is the most popular, and one of the most satisfying, combination cosmetic plastic surgery procedures. With the ability to reshape the breast and flatten the belly, the Mommy Makeover is the procedure of choice to rejuvenate the female form after pregnancy or weight loss.

This Wednesday, June 7, 2017, I will be on the San Francisco Bay Area’s News Station, KRON 4’s Body Beautiful. The show airs live at noon. As usual, the discussion is focussed on the latest Cosmetic Plastic Surgery News for the San Francisco Bay Area.

Body Beautiful Plastic Surgery Topics

This week’s half-hour television show discusses Cosmetic Plastic Surgery of the Body. Planned topics include:

Mommy Makeovers SF Bay Area

The Mommy Makeover Before and After Pictures that leads this post demonstrate the most popular combination cosmetic plastic surgery. By combining Breast Augmentation and Tummy Tucks, the two areas the often sag after pregnancy, the breasts and the belly, are both addressed. Of course, the procedures can be performed without having had children. The term Mommy Makeover was coined because of the frequent request from mommies to repair the damages of pregnancy on their breast and bellies. Another common situation in which Mommy Makeovers are performed is significant weight loss.

EDIT – The first Plastic Surgery Video segment on Mommy Makeovers is up and live right here: Mommy Makeover Video.

Breast Augmentation Mastopexy (Breast Implants with Breast Lifts)

Breast Augmentation remains the most popular single plastic surgery procedure. Breast implants can provide volume, and as many as 40% of patients also benefit from a breast lift. Breast lifts can improve breast shape in ways the Breast Augmentation alone cannot.

Breast Augmentation remains the most popular single plastic surgery procedure. Breast implants can provide volume, and as many as 40% of patients also benefit from a breast lift. Breast lifts can improve breast shape in ways the Breast Augmentation alone cannot.

Breast Augmentation is still one of the most frequently performed cosmetic plastic surgery procedures, but what happens if the breasts are saggy, or the nipple is very low on the breasts? Breast Augmentation in these situations may provide larger breasts, but not necessarily perky ones. As many as 40% of Breast Augmentations combine some sort of Breast Lift. The most common reasons for this are low set nipples or saggy breasts due to excess skin.

Additional procedures can also be added to correct other breast problems, Fine details of the breasts that are often targeted for improvement are: Areola Reduction, the improvement of Breast Asymmetry, Breast Implant Revision for women who had Breast Implants before pregnancy and Inverted Nipple Repair. Breast Reduction, perhaps paradoxically, can also be combined with Breast Augmentation Mastopexy when heavy lower breast tissue is distorting the shape of the breasts.

Brazilian Buttocks Lift

The fastest growing procedure is the Brazilian Butt Lift. The procedure takes fat from areas where it is not desired and repurposes it, to enhance the shape of the buttocks.

The fastest growing procedure is the Brazilian Butt Lift. The procedure takes fat from areas where it is not desired and repurposes it, to enhance the shape of the buttocks.

A newer body procedure is allowing Board Certified Plastic Surgeons to shape an area that traditionally has been difficult. The Brazilian Buttock Lift (BBL), allows us to remove fat with Liposuction and reuse it to enhance the buttock contours. Pioneered by Brazilian Plastic Surgeon, Ivo Pitanguy, the procedure allows for customized augmentation of the buttocks, and shape that is more pleasing to the eye than Buttocks Implants can provide.

Thigh Lifts in the SF Bay Area

The Thigh Lift is used most often after weight loss. Excess skin and fat from the inner thigh is removed to reduce the size of the thighs and tighten the skin.

The Thigh Lift is used most often after weight loss. Excess skin and fat from the inner thigh is removed to reduce the size of the thighs and tighten the skin.

Thigh Lifts are one of the less frequently performed cosmetic plastic surgery procedures. The numbers have risen in response to Bariatric Surgery and the massive weight loss associated with it. As weight is lost, the thigh skin that is stretched during weight gain becomes loose. As the volume of the thigh decreases, so does the support that the extra fat provides the thigh skin. As a result, the skin can hang like drapery. The Thigh Lift removes this excess skin, and helps to tighten the thigh, especially the upper, inner thigh.

Watch Body Beautiful June 7, 2017, on KRON at Noon Wednesday

If you are interested in learning more about any of the above procedures, I have provided links in this post, and I encourage you to watch me live on KRON 4, this Wednesday at noon. Segments from the show will be posted here, on the San Francisco Plastic Surgery Blog, in the coming days. So if you miss the live show, you can still catch up here or on my local San Francisco Plastic Surgery Web Sites.

Internet education can be very helpful, and it is the goal of the San Francisco Plastic Surgery Blog; however, because information on the Internet is designed to apply to the general population, it is generic in nature. Medical advice cannot be giving without the personal contact that an in-person consultation appointment provides. To get “brand name” plastic surgery information, tailored to your specific needs, call my San Francisco Bay Area Plastic Surgery Clinic today, at (925) 943-6353, and schedule an appointment to get your personal, Board Certified Plastic Surgery information.

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2017 BI-ALCL Update (Breast Implant Associated – Anaplastic Large Cell Lymphoma)

Posted February 26, 2017 in Breast Augmentation, Home, Patient Safety

The 2016 diagnostic algorithm for BI-ALCL, shown in the flowsheet above, is still the recommended treatment. If you experience breast implant enlargement, breast inflammation, breast pain, a breast lump, a breast sore or feel like there is fluid around your breast implant, follow up with your plastic surgeon or primary medical doctor ASAP.

The 2016 diagnostic algorithm for BI-ALCL, shown in the flowsheet above, is still the recommended treatment. If you experience breast implant enlargement, breast inflammation, breast pain, a breast lump, a breast sore or feel like there is fluid around your breast implant, follow up with your plastic surgeon or primary medical doctor ASAP. (Click image for larger view.)


It’s been about six months since the last San Francisco Plastic Surgery Blog ALCL update. Recently, more information on the subject has become available, and it is about to be published. Two articles stand out. The first is from the United States, and the second is a global review of what is known to date. Both were recently e-published, ahead of print, in the American Society of Plastic Surgeons’ (ASPS) journal, “Plastic and Reconstructive Surgery.” Here are the latest facts…

What is BI-ALCL?

ALCL Histology

Breast Implant Associated – Anaplastic Large Cell Lymphoma (BI-ALCL) is a T-cell lymphoma that arises around breast implants. It is an extremely rare tumor, which makes it difficult to study; however. earlier data suggests that it is primarily associated with textured breast implants.

The Latest Plastic Surgery News

The first article by Doren et al, entitled: United States Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma, reviews all cases of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BI-ALCL) in the United States since the first documented case in 1996 up to and including cases reported in 2015. The study is retrospective, so it is not an ideal study for determining the incidence of the disease; however, it’s the best guess we have to date, and the conclusions seem fair. Although rare, all cases of BI-ALCL with adequate history have involved a textured breast implant. The incidence and prevalence of BI-ALCL was determined based on a literature and institutional database review of BI-ALCL cases and textured breast implant sales figures from implant manufacturers’ annualized data.

2017 United States BI-ALCL Data

One hundred pathologically confirmed BI-ALCL cases were identified in the United States. Mean age at diagnosis was 53.2±12.3 years. Mean interval from implant placement to diagnosis was 10.7±4.6 years. Forty-nine patients had breast implants placed for cosmetic reasons, 44 for mastectomy reconstruction, and seven for unknown reasons. Assuming BI-ALCL occurs only in textured breast implants, the incidence rate is 2.03 per 1,000,000 person-years (203 per 100 million), which is 67.6 times higher than that of breast ALCL (3 per 100 million; p<0.001). Lifetime prevalence was 33 per million persons with textured breast implants.

2017 Global BI-ALCL Data

The second article by Srinivasa et al, entitled: Global Adverse Event Reports of Breast Implant-Associated ALCL: An International Review of 40 Government Authority Databases, reviews all federal database submissions relating to BI-ALCL in 37 countries representing the majority of breast implant markets worldwide with available adverse event reporting. Database queries were performed for Australia, Brazil, Canada, China, Columbia, Japan, Mexico, National Competent Authorities of the European Member States, New Zealand, South Korea, and United States. Demographics, device characteristics, pathology, treatment modalities, and outcomes were assessed when available.

The United States MAUDE database included 459 entries in total for the search terms “Anaplastic” and “ALCL” as of September 2015. Excluding for duplicate entries, the MAUDE database had 258 unique cases of BI-ALCL of which 130 had pathologic markers performed. Implant surface was textured significantly more than smooth (50% vs. 4.2%, p=0.0001). Treatment, when reported (n=136), included explantation (n=125, 91.9%), chemotherapy (n=42, 30.8%), radiation (n=25, 18.4%), and/or stem cell transplant (n=9, 6.6%), and 5 deaths were reported. For the 40 countries queried, 340 unique cases were reported for lymphoma associated with breast implants.

They concluded that worldwide federal reporting of BI-ALCL has significant limitations in providing data regarding clinical history, treatment, and oncologic follow up. Country-specific total implant and textured implant sales data is needed in order to determine critical incidence and prevalence analysis. Detailed BI-ALCL patient registries such as American Society of Plastic Surgeon’s PROFILE and centralized tissue banking are necessary in acquiring accurate complete data for sound decision making. The good news for American’s here is that the American Society of Plastic Surgeons are leading the way in accurate and appropriate reporting.

What To Do If You Think You Have BI-ALCL

The most common presentation of BI-ALCL is a collection of fluid that occurs around your breast implants years after surgery. BI-ALCL is not the most common cause of these late seromas, but sending a sample may be the fastest way to make the determination. Other presentations include a mass attached to the capsule, tumor erosion through the skin, regional lymph node involvement, or sometimes it is discovered during revision surgery. Risk estimates ranged from one in 500,000 to one in 3 million women with implants.

The typical presentation of ALCL is a large seroma (fluid collection) around the breast implant causing obvious enlargement and asymmetry of the breast augmentation.

The typical presentation of ALCL is a large seroma (fluid collection) around the breast implant causing obvious enlargement and asymmetry of the breast augmentation.

If you suspect there is a problem with your Breast Implants, whether related to BI-ALCL or not, contact an experienced Board Certified Plastic Surgeon in your area. If your original Plastic Surgeon is still in practice near-by, this would be the best place to start. They have your clinical information, and a head start in the investigation. If you have moved, or your plastic surgeon has retired, try to get a copy of your medical records. This will help your new Plastic Surgeon get to the facts much faster.

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Breast Implant Removal – SF Bay Area

Posted October 15, 2016 in Breast Implant Removal, Breast Implant Revision Surgery, Home

If your are feeling that your Breast Implants are too big, like the bowling balls Holly Madison is holding at the Bowling For Boobies Fundraiser in Hollywood, CA, it might make sense to have them reduced or even removed. About 1% of women who get Breast Implants will elect to have them removed at some point in their life.

If your are feeling that your Breast Implants are too big, like the bowling balls Holly Madison is holding at the Bowling For Boobies Fundraiser in Hollywood, CA, it might make sense to have them reduced or even removed. About 1% of women who get Breast Implants have them removed at some point in their life.

Breast Implant Removal is not the most popular Cosmetic Plastic Surgery procedure. In fact, for most of my Breast Augmentation patients, Breast Implant Removal is unthinkable. Longterm plastic surgery statists show that only about 1% of women who get Breast Implants have them removed. Sometimes it is elective; sometimes it is medically necessary.

Why Have Breast Implants Removed?

Breast Implant Removal Before and After: This patient has great breast skin elasticity, so she has no skin sagging after her Breast Implant Removal. Breast Implant Remova surgery is just as personal as Breast Augmentation surgery, and the reasons for it vary. Only 1% of all Breast Augmentation patients have their Breast Implant removed.

Breast Implant Removal Before and After: This patient has great breast skin elasticity, so she has no skin sagging after her Breast Implant Removal. Breast Implant Remova surgery is just as personal as Breast Augmentation surgery, and the reasons for it vary. Only 1% of all Breast Augmentation patients have their Breast Implant removed.

While it is not common, there are many reasons for Breast Implant Removal. Since Breast Implants are used for both an elective and reconstructive procedure, the reasons for Breast Implant Removal can also range from elective to required.

Elective Reasons: Changes in one’s personal physique preference, body image and physical changes associated with weight, pregnancy or aging can all lead to a desire for less breast augmentation. Elective reasons For Breast Implant Removal include:

  • Breast Implants were placed at a young age and things have changed
  • Increased breast size after pregnancy
  • Increase in breast size associated with menopause
  • Planning to get pregnant and don’t want breasts to have a head-start in getting stretched out
  • Breast Implants are just no longer desirable or wanted

Required Reasons: Required reasons for Breast Implant Removal is more common for Breast Reconstruction patients than for elective Breast Augmentation patients. Reasons include:

  • Breast Implant Deflation (In most cases the Breast Implant is replaced rather than left out)
  • Breast Implant Infections
  • Breast Implant Exposure
  • Other severe complications of Breast Implants where the pocket needs to be reconstructed
  • Uncommon forms Breast Cancer treatment which include Hyperthermia

How Are Breast Implants Removed?

Breast Implant Removal Before and After Photos: Larger implants and less native breast tissue increase the desire for a Breast Lift after Breast Implant Removal Surgery. This patient  above had large volume breast implants, small natural breast tissue volume, but good skin tone and nipple placement. She elected not to have a Breast Lift.

Breast Implant Removal Before and After Photos: Larger implants and less native breast tissue increase the desire for a Breast Lift after Breast Implant Removal Surgery. This patient above had large volume breast implants, small natural breast tissue volume, but good skin tone and nipple placement. She elected not to have a Breast Lift.

Uncomplicated Saline Breast Implant Removal can be performed under local, local with sedation or general anesthesia, depending on the motivation and tolerance of my patient. Silicone Breast Implant Removal is more often performed under general anesthesia. The reason for the difference is in the filling.

Saline Breast Implant Removal

Saline Breast Implants are filled with water essentially. The implants can be opened, the contents suctioned out and the implants’ silicone shell can be removed without fear of spillage through a small incision. While many saline breast implants were placed via a peri-areolar incision, they are often removed via the infra-mammary fold incision (IMF) to decrease the risk of dimpling at the areolar incision.

Silicone Breast Implant Removal

Silicone Breast Implants are filled with silicone gel. Unlike a Saline Breast Implant, it is sometimes difficult to know before surgery if a silicone breast implant is ruptured. Even MRIs are only 90% accurate. If your silicone breast implant is ruptured, more needs to be done than just remove the implant, so your surgeon will want to have the option, and this is more easier on you, and your surgeon, under general anesthesia. This is especially true of breast implants manufactured before 1994. These can have free silicone gel in the pocket around the implant, even without being ruptured due to “gel bleed.”

After Breast Implant Removal Will I Need A Breast Lift?

Breast Implant Removal Before and After Pictures: The patient above wanted her Breast Implants removed because she felt too big. She also has some bottoming-out of her breast implants. Her breast implants were removed and a special, inferior-pole lift was performed to reduce the amount of skin hanging below her nipple and to move the native breast tissue that she had back up under the nipple.

Breast Implant Removal Before and After Pictures: The patient above wanted her Breast Implants removed because she felt too big. She also has some bottoming-out of her breast implants. Her breast implants were removed and a special, inferior-pole lift was performed to reduce the amount of skin hanging below her nipple and to move the native breast tissue that she had back up under the nipple.

This is question that can only me answered with a Plastic Surgery Consultation. In general, the larger your implants and the smaller your natural breasts, the more likely you are to need a lift. An option that is always available though is to have the Breast Implants removed, allow the breasts to heal and then evaluate if a lift is beneficial. While this means two operations, it also means that you can make the decision to lift or not to lift without having to guess what your breast will look like without breast implants.

Recovery After Breast Implant Removal

Recovery after Breast Implant Removal is usually pretty quick. Most patients are wearing a firm, jog-type bra immediately after surgery to help the breast implant pocket seal and heal. Light compression provides decreased swelling, increased support and decreased discomfort after surgery. In cases where full capsulectomies are performed, or when free silicone needs to be removed, more surgery is required, so the recovery would be expected to increase proportionately with the amount of additional work required.

To schedule a Breast Implant Removal consultation, give my San Francisco Bay Area Plastic Surgery Office a call at (925) 943-6353. We are centrally located in the SF East Bay city of Walnut Creek, CA.

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Breast Implant Revision Video – SF Bay Area

Posted September 11, 2016 in Breast Implant Revision Surgery, Home, Videos

Breast Augmentation Revision is a specialty unto itself. It includes any Breast Implant Revision for breast implant replacement, deflation or for a change in size or style. Other reasons for Breast Augmentation Revision include correction of capsular contracture and breast implant malposition like bottoming out, symmastia (uniboob), lateral displacement and double bubble. A rare Breast Implant Complication, Breast Implant Erosion, was reviewed in last week’s Body Beautiful Sneak Peek.

Breast Augmentation Revision Video

This Breast Implant Revision Video reviews some of the most common reasons for correction and shows Breast Augmentation Revision Before and After Pictures to illustrate what Breast Augmentation Revision can do.

Breast Implant Complications corrected in this video include:

  • Breast Implant Deflation
  • Symmastia (Uniboob or Breadloafing)
  • Capsular Contracture
  • Breast Implant Malposition (implants in the wrong place)
  • Breast Implant Erosion
  • Adjustment of Breast Implant Size

Breast Implant Revision Video

Breast Augmentation Revision Consultation

Breast Implant Revision covers a wide variety of procedures. If you have had Breast Augmentation, and are considering breast revision surgery to improve your results, call (925) 943-6353, today, and schedule your private and personalized consultation.

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Body Beautiful On KRON4 Wednesday At Noon – Live

Posted September 04, 2016 in Asian Eyelid Lift (Asian Blepharoplasty), Breast Augmentation, Breast Implant Revision Surgery, Breast Reduction, Breast Reduction (Men), Capsular Contracture, Ear Shaping (Otoplasty), Eyelid Lift (Blepharoplasty), Home

Attention Plastic Surgery Television viewers. Body Beautiful will be broadcast live on KRON4 this Wednesday, September 7, 2016, At Noon – Live. So tune-in to get the latest Plastic Surgery News, and see if I get it right on the first take.

Plastic Surgery Topics Will Include…

This week’s show will be thirty minutes packed with what’s new in Cosmetic Plastic Surgery. Topics will some of the most popular procedures here in the San Francisco Bay Area including:

  • Breast Augmentation Revision for…
    • Breast Implant Deflation
    • Breast Implant Exposure (Skin Erosion)
    • Capsular Contracture
    • Symmastia
    • Breast Implant Malposition
    • Breast Asymmetry
    • Breast Implants too small
  • Gynecomastia Reduction (Male Breast Reduction)
  • Otoplasty (Ear Pinning for Prominent Ears)
  • Asian Blepharoplasty (Asian Eyelid Surgery)

There will be plenty of discussion and Before and After Pictures for illustration. Below is a sneak peek.

Breast Augmentation Revision

The patient below had a rare, but serious Breast Augmentation Complication, requiring staged Breast Augmentation Revision Surgery. Her breast implant nearly eroded through the skin on the bottom of her left breast. Oversized Breast Implants in small breasts with poor soft-tissue coverage are at greater risk. This is more commonly seen after Breast Reconstruction when the breast has been radiated to treat breast cancer. It is unlikely to occur in a young, otherwise healthy woman, but it did.

Breast Implant Revision: Sometimes breast implant revision is urgent. The square shape sticking out of the bottom of this patient's left breast is her breast implant, and it's about to fall out.

Breast Implant Revision: Sometimes breast implant revision is urgent. The square shape sticking out of the bottom of this patient’s left breast is her breast implant, and it’s about to fall out.

Breast Augmentation Revision Stage I – The Salvage Operation

The top row of photos are the before and after photos from the first stage of her Breast Implant Revision Surgery. The upper left photo shows that the patient’s left Breast Implant is eroding through the skin of the lower breast. It’s about to fall out, and the current breast implant needs to be removed, urgently. If the Breast Implant becomes exposed, infection quickly follows. After careful discussion, it was decided to proceed with Breast Implant Removal on both sides.

Breast Augmentation Revision - Stage I was urgent removal of the left breast implant, which had nearly eroded its way through the lower pole of the breast. It was elected to remove both implants during stage I, because replacing the original saline breast implants with smaller silicone gel filled breast implants was part of the plan to decrease the risk of recurrence.

Breast Augmentation Revision – Stage I was urgent removal of the left breast implant, which had nearly eroded its way through the lower pole of the breast. It was elected to remove both implants during stage I, because replacing the original saline breast implants with smaller silicone gel filled breast implants was part of the plan to decrease the risk of recurrence.

Having one implant in and one implant out was an option, but would have left her with an almost undisguisable amount of asymmetry. Moreover, the plan was to use smaller replacement implants, to decrease the risk of another breast implant erosion. Leaving both implants out forever would also treat this problem, and completely eliminate any chance of it happening again.

Breast Augmentation Revision Stage II – Asymmetric Breast Augmentation

While the nearly Exposed Breast Implant problem was solved, there were two new problems: 1) obvious breast asymmetry and 2) breasts which are too small for my patient’s preferences. The Breast Asymmetry is two fold. The left breast is smaller than the right, and the left breast is higher and tighter on the chest wall.

Breast Augmentation Revision Surgery - Stage II. The second stage entailed lowering the left implant pocket, expanding the lower, contracted pole of the left breast and asymmetrically augmenting the breasts to decrease the size difference.

Breast Augmentation Revision Surgery – Stage II. The second stage entailed lowering the left implant pocket, expanding the lower, contracted pole of the left breast and asymmetrically augmenting the breasts to decrease the size difference.

Breast Implant Revision Surgery was performed to asymmetrically increase the size of the breasts, and to lower the left breast to match the right. The initial results are shown above, just one week after surgery. An alternative approach would be to raise the right side with a Breast Lift; however, this would require additional, external scars on the right breast.

As time marched on, the results improved. No additional surgery was performed after stage two. While initially the skin stretched well, the muscle was tight. Over several months the muscle relaxed and the symmetry improved, as expected.

Breast Augmentation Revision Surgery – Stage II and a patient patient. As time marched on, the results improved. No additional surgery was performed after stage II. While initially the skin stretched well, the muscle was tight. Over several months the muscle relaxed and the symmetry improved, as expected.

The Breast Revision Before and After Photos above show the results after new, smaller Silicone Breast Implants were placed, and the breasts were allowed to heal. The left picture is one week after surgery. In this photo, the left breast mound is firmer, higher and more projecting, as would be expected when more stuffing is placed in a smaller pillow case.

As the breasts heal, the left breast skin and muscle relax, the left breast implant descends and her results improve. The right, after photo shows the results after a few months. A larger breast implant was used on the left, to correct the asymmetry, and while initially it may seem like her Breast Implant Problems are not completely corrected, over time, it settles down. It is a good deal better than the potentially life-threatening complication she presented with originally, as shown below.

Breast Implant Revision Before and After Photos - the left picture is how the patient initially presented. The second picture is a few months after completion of both stages (breast implant removal and breast implant replacement with pocket modifications).

Breast Implant Revision Before and After Photos – the left picture is how the patient initially presented. The second picture is a few months after completion of both stages (breast implant removal and breast implant replacement with pocket modifications).

Breast Augmentation Revision Consultations

Breast Augmentation Revision is considerably more complicated than primary Breast Augmentation. If you have problems with your Breast Implants, seek an experienced and Board Certified Plastic Surgeon for your revision surgery. If you are in the San Francisco Bay Area and would like to schedule a personalized consultation appointment call (925) 943-6353, today.

PS – Don’t forget to watch Body Beautiful live at noon, this Wednesday, September 7, 2016, on KRON4, the Bay Area’s New Station.

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